Thank you for choosing our practice. We are committed to building a successful provider-patient relationship with you and your family. Your clear understanding of our Patient Financial Policies is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please ask if you have any questions about our fees, our policies, or your responsibilities.

Missed or cancelled appointments:
There will be a $50 - $100 fee for missed appointments or appointments without a 24-hour cancellation notice depending on the length of appointment cancelled or missed. This charge cannot be billed to your insurance; therefore, it will be solely your responsibility. After 3 consecutive missed appointments or late cancellations, you may be dismissed from our practice.

Returned Checks:
The charge for a returned check is $30 payable by cash or money order. This will be applied to your account in addition to the insufficient funds amount. It is expected that the insufficient funds and returned check fee is paid immediately upon notification from us or your financial institution. Your account may be placed on a cash only basis following any returned check until the practice deems you are no longer a financial risk.

Self-Pay Accounts:
Self-pay accounts are patients without insurance coverage and are required to pay in full at the time of service. At time-of-service payments may not always be accurate and if so the discrepancy on billed charges will be reflected on your next statement.

Medical Insurance Accounts:
We will bill your primary, secondary, and/or tertiary insurance companies as a courtesy to you. To properly bill your insurance companies, we require that you disclose all insurance information in a timely manner. All insurance information must be provided to us within 30 days of your appointment. Failure to do so will result in charges being your full responsibility without insurance involvement. If you provide us with inaccurate insurance information and you fail to provide us with updated information within 30 days, the charges will be your responsibility. If due to your inability to give us accurate insurance information we receive claim denials referencing timely filing with your insurance company, you will be held responsible for payment of the denied charges.
Insurance is a contract between you and your insurance company. Every insurance plan has copays, deductibles, and coinsurance obligations that their members must meet. We make every effort to get your general medical health benefits and with this information provided our office has its expectations of you as our patient. We expect you to pay your contracted copays, deductibles, and coinsurance at time services are rendered on the estimated charges. We do our best to estimate but if our estimate does not include services that were provided, we will bill those in addition to the prepaid estimated charges to your insurance. Once all charges have been processed by your insurance any balance that remains will be your responsibility to pay. We do not take responsibility for knowing your contract verbatim with your insurance. It is your responsibility to know whether we are preferred in network providers, what your policy considers in terms of covered, non-covered and experimental or investigational procedures. If we are out of network with your insurance company, you will be required to pay the above usual and customary allowances on all charges. If your insurance company issues you payment for our services, you are required to pay us in full for those services you were paid. Ultimately it is the insurance company that makes the final determination of your eligibility and benefits once they receive the insurance claim and process it according to your plan. If we have exhausted all our efforts in collecting from your insurance and payment is delayed over 90 days you agree to take full responsibility for all charges that are delinquent on your account.
We will not fraudulently change diagnoses from the supporting documentation for a better outcome from your insurance company.

Outstanding Balance Policy:
It is our office’s policy to have you place a credit/debit card on file for any outstanding balances. (Please reference Credit/Debit Card Policy for details). Our office policy is that all accounts are paid for within 90 days. If your account is 60 days past due your account will be entering the collections process if payment is not received when you are contacted via phone on your outstanding account. If your account balance is not paid one week from the date of the call your account will be sent to our Third-Party Collections Agency. When your account is turned over you will not only be responsible for your balance with us but fees that accumulate from the first delinquent date. The collection agency determines these fees and once your account is turned over you will be sent to them to discuss your debt. Once your account is turned over to the collection agency you will be considered discharged from our practice until financial obligations have been met and satisfied. If financial obligations are met, it will be at the discretion of the providers whether they will welcome you back into the practice as a cash pay only client. All outstanding balances prior to assignment to Third Party Collections Agency will be subject to a monthly late payment fee of $25 and 1.5% monthly interest charge on the running balance by our practice.

Referrals and Authorizations:
We may sometimes perform services that your insurance company may need prior approval on. As a courtesy we will try to get prior approval for services that in general most insurance companies may require prior approval for such as infertility treatment and surgical procedures requiring hospital setting. However, it is not our responsibility, nor will we take responsibility if prior approval was needed for services rendered that were not obtained. It is your responsibility as the policy holder to take the steps necessary to inquire about treatment prior approval requirements. If such services are provided and are denied for prior approval all charges will be your responsibility. We always want you to be actively involved in knowing your insurance benefits.
Sometimes we work with Third Party Vendors that may not be in network with your insurance plan. We advise you to ask who we work with regarding lab & pathology processing, preventative services that are outsourced and surgical facilities as well as providers who may be involved in the operating room.

Minors:
The parent(s) or guardian(s) is responsible for full payment of services and will receive the billing statement. Minors must be accompanied by a parent or guardian unless a signed release to treat and financial arrangements have been made prior to services.

Medical Records Copies:
All requests for medical records must be in writing, please allow us 10 business days to complete the request. This is within the legal requirement of the State of Montana. Please be advised that there is an administrative fee of $15 and a fee of $0.50 per page and this is assessed at the discretion of our office and is in accordance